Provider Demographics
NPI:1447077219
Name:IMBUIDO, JANUARY AYSON (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JANUARY
Middle Name:AYSON
Last Name:IMBUIDO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4321
Mailing Address - Country:US
Mailing Address - Phone:224-848-2195
Mailing Address - Fax:
Practice Address - Street 1:2405 BIG WOODS DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-7650
Practice Address - Country:US
Practice Address - Phone:630-277-9651
Practice Address - Fax:847-972-6265
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.030460363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology